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Hassoun, one of just two trained surgeons at this hospital in northwestern Syria, says the waiting room is often filled to capacity.

"Imagine 100 people complaining about their pain and telling you their stories?" Hassoun told °®Âþµº over WhatsApp. "It makes our work very stressful."

Two years ago, Hassoun was in the middle of an emergency abdominal surgery when the hospital was bombed. Amid the chaos, he and a nurse finished their work in the dark while the rest of the hospital evacuated.

Since then, staff have carried on with routine and emergency services, despite significant damage to the facility. 

As a doctor at one of the main hospitals still functioning in this part of Idlib, Hassoun says he and his colleagues are overwhelmed by an influx of patients displaced from elsewhere in northwestern Syria.

"The number of patients is increasing," he said. "As for surgeries, the number has almost doubled since July."

	Read also: 'Mum, I don't want to die': Syrians flee Idlib for miserable displacement camps

In late April, forces loyal to Syrian President Bashar al-Assad launched a military offensive on Idlib province, the last major stronghold of the opposition after nearly eight years of war.

The air and land campaign has left and forced half a million to flee their homes, according to the United Nations.

Under the pretext of attacking terrorists, pro-government forces have targeted schools, hospitals and other residential areas in Idlib. According to the UN at least have been damaged or destroyed in the past five months.

Both Damascus and Moscow say they are targeting extremist groups including Hayat Tahrir al-Sham, not civilians. In a July letter to the UN, the Syrian government claimed that health facilities in the Idlib province had been rendered "out of commission since being taken over by terrorist groups" and therefore could not be considered "civilian objects." 

But Rayan Koteiche, the Physicians for Human Rights (PHR) researcher for the Middle East and North Africa, says it's clear that civilians living in opposition-controlled territory are the regime's primary target.

"The attacks have become so frequent," Koteiche says, "that even armed combatants that seek to deploy in certain areas, or even set up bases, tend to do so away from medical facilities," said Koteiche. 

"[Hospitals] have become associated with this sort of targeting, and combatants are staying away from them."

As part of a process known as deconfliction, hospitals and other humanitarian facilities in Idlib shared their GPS coordinates with the UN Office for the Coordination of Humanitarian Affairs (OCHA).

PHR says it has corroborated 583 attacks on at least 350 separate health facilities and the killing of 912 medical personnel between March 2011 and August 2019

The UN then gave those locations to the warring parties, including Syria and Russia, in an effort to prevent civilian casualties. But rights groups say the location-sharing has done little to deter regime airstrikes and may have even increased the likelihood of such attacks.

The targeting of health care in Syria is nothing new. Assad's forces have for years systematically targeted hospitals in what experts say is an attempt to render entire areas unliveable.

Over the course of eight years, have been killed, according to the Syrian American Medical Society, a medical relief organisation.

PHR says 583 attacks on at least 350 separate health facilities and the killing of 912 medical personnel between March 2011 and August 2019. Ninety-one percent of attacks, the organisation says, were perpetrated by the regime and its allies.

"The Syrian government knows exactly what the impact of such attacks is." Koteiche says. "It leads to either people moving or capitulating because there are no other options."

Like many of those living in Idlib, Torki al-Hamadi fled regime attacks elsewhere in the country. When his hospital in Aleppo was bombed in 2015, he and his family moved to Idlib countryside in search of shelter. He's now working as an anesthesia technician at a SAMS-supported hospital. 

Despite a unilateral ceasefire announced by Russia at the end of August, activists and monitoring groups have reported sporadic artillery shelling in civilian areas across Idlib.

In late September, al-Hamadi said explosions were heard in a neighbourhood near his hospital. When al-Hamadi's ambulance arrived on the scene, they found a young boy and mother covered in blood. 

As they raced to the hospital, al-Hamadi's thoughts drifted toward his own family. 

"It's a difficult feeling, almost embarrassing, to describe," al-Hamadi said. "But sometimes I imagine, what if my wife and children were injured?" 

"When I leave out of my house and say goodbye, I'm prepared to not come back to them."

Elizabeth Hagedorn is a freelance journalist focusing on migration and conflict with bylines in The Guardian, Middle East Eye and Public Radio International.

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